Clinical and morphologic observations are described in five patients who had severe aortic regurgitation (AR) from severe systemic hypertension unassociated with aortic dissection and each patient underwent aortic valve replacement. Although AR of minimal or mild degree is well recognized to occur in patients with systemic hypertension, severe degrees of AR in such patients is rare and, aortic-valve replacement in such patients has not been reported from other centers. Why our five patients developed such severe AR, however, was not determined. Although a rare cause, systemic hypertension, nevertheless, must be added to the list of causes of severe pure AR.